Hyopfractioned or standard external beam radiation therapy – which is better?

This study compared external beam radiation therapy (EBRT) and hypofractioned EBRT (H-EBRT) for low-risk localized prostate cancer. Researchers reported no differences in disease progression or survival. However, an increase in side effects was observed with H-EBRT.

Radiation therapy is a common treatment for localized (confined) prostate cancer. External beam radiation therapy (EBRT) involves directing high-energy rays from outside the body at the tumor site to kill cancer cells. EBRT is associated with effective cancer control. Increasing evidence is suggesting that hypofractioned EBRT (H-EBRT) may achieve similar results. H-EBRT involves giving larger doses of radiation per treatment, reducing the number of total treatments. Fewer treatments are generally more convenient for the patient and can decrease health care costs. More studies are needed to demonstrate that H-EBRT can achieve similar results to EBRT.

This study directly compared H-EBRT with EBRT. 1,092 men with low-risk localized prostate cancer were randomly assigned to either H-EBRT (70 Gy in 28 fractions over 5.6 weeks) or EBRT (73.8 Gy in 41 fractions over 8.2 weeks). Treatment outcomes were followed for an average of 5.8 years.

No significant differences in disease progression, recurrence, or overall survival (time from treatment until death from any cause) were noted. 5-year disease-free survival was 85.3% for EBRT and 86.3% for H-EBRT. Cancer recurrence (based on blood tests) was observed in 8.1% of men undergoing EBRT and in 6.3% of men undergoing H-EBRT. 5-year overall survival was 93.2% in the EBRT group and 92.5% in the H-EBRT group.

The rate of early side effects (occurring within 90 days after radiation) was similar for both treatment groups. Late-onset gastrointestinal (stomach and intestines) and genitourinary (genital and urinary organs) side effects were 55%-59% more common following H-EBRT. However, very serious side effects were rarely observed (in less than 1% of men).

Researchers concluded that H-EBRT is as effective as EBRT and provides a suitable alternative treatment option for men with low-risk localized prostate cancer, but with a small increase in side effects.